Substance Abuse and the E.R.

Substance Abuse and the E.R.

In 2010 I wrote about an emergency room doctor who has a blog on www.medpagetoday.com.The particular post I was interested in was about a homeless man suffering from alcoholism who had ended up in the ER, as so many people without health insurance do.

The link between the E.R. and substance abusers is in the news again. First, Kaiser Health News noted on www.everydayhealth.com, that up to half of the people seen in the E.R. are under the influence of alcohol. What a statistic. We know that drinking causes accidents and results in fights and worse, but….up to half? That’s enlightening (or sobering, to quote the article’s play on words.). The article also points to a study showing that a brief intervention by an E.R. doctor can help in these circumstances.

However, what I found most interesting is that in more than half of states, insurance companies can deny payment for E.R. services if a person is found to be under the influence of alcohol and other drugs. Plus, ER personnel may not test for drug use to circumvent the payment problem. (There’s that humanity again that I wrote about in 2010.) Level 1 and 2 trauma centers, which handle a large number of people involved in car accidents, must screen, however. (By the way, the article also has a link to a site I found interesting – the National Institute on Alcohol Abuse and Alcoholism’s [or NIAA’S] Alcohol Policy Information System, which bears checking out.)

The article was mostly about how the brief counseling helps, but the writer – or at least the headline writer, or the site – chose to focus on the nonreimbursement issue. An example detailed the case of one woman who admitted to having a few drinks after she broke her ankle. Her insurance company refused to pay (which explains the subtitle of the article — “Excessive drinking could come at a high cost for your health and your wallet.”)

A second article about substance abuse and the E.R. that appeared recently involves people who show up at these centers complaining of toothaches. To the doctor quoted in the article, it’s often “a ruse to get prescriptions for narcotics.”

Sure, there are people who can’t get into a dentist because they don’t have the funds. Or maybe it’s a weekend. But after I just posted on the lengths people will go to to get high, it makes sense that they would try this, too. The people who appear in the E.R. have even said they’re allergic to everything except Vicodin, according to the doctor, who said that’s a dead giveaway.

He also mentioned doctor shopping, wondering if many of these people go on to another emergency room to get more pills. All the more reason for all states to have a prescription database and make it mandatory for healthcare professionals to use it! The article said that 40 states now have these programs and eight more have legislation to create them.